Transcript CLINICAL NEUROPSYCHOLOGY IN DEVELOPING COUNTRIES: …

CLINICAL NEUROPSYCHOLOGY IN
DEVELOPING COUNTRIES: THE
SOUTH AFRICAN EXPERIENCE
Ann Watts
Univ of KwaZulu-Natal; Univ of Zululand
ICTP-2008
Status of Clinical Neuropsychology in
Developed Countries
Over the past 60 years, clinical neuropsychology
has developed into a distinct specialty
Creation of training standards & qualifications for
clinical practice (e.g. US, UK).
Clinical neuropsychology integrated into the
healthcare system. The result is improved care
& clinical outcomes for patients with
neuropsychological diseases
Status of Clinical Neuropsychology
in Developing Countries
In developing countries high incidence of
brain damage.
Limited access to healthcare facilities.
Number of psychologists relative to
population low so specialization rare.
Training standards & qualifications for
clinical practice not delineated.
Dearth of formal training programs.
Challenges for the Development of
Clinical Neuropsychology in South
Africa
Multi-lingual & multi-cultural society in a rapid
state of transition.
Inequalities in educational & health status.
If neuropsychological services do exist they are:
Urban-based
Assessment dominated.
Acute rehabilitation facilities may be available.
Post-acute rehabilitation facilities lacking.
TRC Recommendations on the
Health Sector: Mental Health
Services be accessible to all, with
particular emphasis on rural areas
Focus of services shift from one-on-one
therapy to become community based
Different care & therapy models be
explored & instituted, particularly
traditional & indigenous modes of
treatment.
TRC Recommendations on the
Health Sector: Mental Health
Community counselors & family members
be involved in care provision.
Psychometric tests that are culturally
appropriate in all aspects be developed
and applied
Services have a developmental focus
Challenges for the Development of
Clinical Neuropsychology in South
Africa
Neuropsychological services need to be:
- affordable
- accessible (devolution of skills)
- appropriate (development of culturally
appropriate assessment & intervention
procedures)
Tiered system of delivery
Specialist neuropsychologist
Psychologist (Masters level)
Registered councilor (4 year degree)
Mental health assistant (2 year diploma)
Primary healthcare worker
Current Limited Training for
Psychologists
Clinical, counseling & educational
psychology masters students receive
basic instruction in neuropsychological
assessment & intervention.
At University of KwaZulu- Natal comprises
10 seminars
Recommended Curriculum for
Professional Training in Clinical
Neuropsychology
Post-lisencing, usually in clinical field
Masters level degree
Usually at least 2 years post-training
clinical experience that includes a special
interest in clinical neuropsychology
Course work: full-time over 1 year or parttime over 2 years
Curriculum of Course Work Module
A. Neurosciences & Human Neuropsycholgy
Neuroanatomy, clinical neurology,
neuroradiology, pharmacology & psychiatry for
clinical neuropsychologists
Neuropsychology of perceptual, cognitive and
executive processes
Neuropsychology of development and
developmental disorders
Neuropsychology of ageing and the dementias
Research design for neuropsychology
Curriculum of Course Work Module
B. Specific Clinical Neuropsychology Training
Neuropsychological assessment techniques:
theoretical & practical instruction
Neuropsychological rehabilitation: theory &
practice
Indigenous knowledge & culture
Ethics for neuropsychologists
Practicum: Assessment & intervention (children
and/or adults) in a supervised assessment
facility
Curriculum of Course Work Module
C. Optional Seminars
Optional attendance at seminars offered
by the departments of Neurology,
Neurosurgery, Radiology, Anatomy &
Pharmacology.
D. Research dissertation
Clinical Neuropsychology
Internship
1 year; 2 years in exceptional
circumstances
Preferably hospital based, but as dearth of
internship sites in South Africa can be
conducted in private practice setting,
provided that practice exposes intern to
didactic & experiential requirements
Clinical Neuropsychology
Internship
1. Didactic training
Neurological diagnosis
Consultation to neurological, neurosurgical,
psychiatric, pediatric & general medical
services (including ward rounds, seminars, etc)
Consultation to patients & referral sources
Neuropsychological assessment, interpretation
of test results, & report writing
Neuropsychological rehabilitation
Clinical Neuropsychology
Internship
2. Experiential Training
Neuropsychological examination & evaluation of
clients with actual & suspected neurological
diseases & disorders, as well as psychiatric,
pediatric & general medical disorders
Participation in clinical activities with
Neurologists & Neurosurgeons (e.g. ward
rounds)
Direct consultation to patients regarding
neuropsychological issues
Consultation to referral & treating professions